Since May 2, 2022, Home and Community-based Services (HCS) and Texas Home Living (TxHmL) program providers, local intellectual and developmental disability authorities (LIDDAs), and financial management services agencies (FMSAs) billing on behalf of consumer-directed services (CDS) have been submitting claims and forms to the Texas Medicaid & Healthcare Partnership (TMHP). TMHP has received feedback from providers and LIDDAs indicating that additional support is required. Resolutions regarding the most frequently reported issues are presented in the table below.
Topic |
Resolution |
Client on Hold Removal |
The following list describes the types of holds and how to remove them:
Note: When returning an individual to service, the provider or LIDDA will need to use the 3615 form if there is one on file after the IMT Suspension. For individuals who do not have a 3615 form after the IMT Suspension, the return to service function on the IMT Suspension form should be used.
|
View a List of All Clients on Hold Through the Dashboard |
Providers can view a list of all clients on hold by using the LTC Online Portal (OP) Dashboard. Refer to the Assigning Permissions & Accessing the LTCOP Dashboard video in the HCS and TxHmL YouTube playlist. Providers can also refer to the Dashboard section of the LTC HCS and TxHmL Waiver Programs Provider User Guide for more information on how to view information for individuals, including hold details. |
HHSC Will Accept Current IPC Form with Handwritten ISS |
The Texas Health and Human Services Commission (HHSC) is aware that the current printable IPC form on the HHSC website does not include Individualized Skills and Socialization (ISS) services to replace day habilitation. Providers and LIDDAs can handwrite the ISS service on the form, and HHSC will accept the form. |
Common Claim Rejections and Steps to Avoid Rejections
HCS and TxHmL providers and LIDDAs might see one of the following explanation of benefits (EOBs) when a claim is rejected:
Explanation of Benefits |
Description |
F0077 |
Billing Code was not submitted or cannot be determined. |
F0138 |
A valid Service Authorization for this client for this Service on these dates is not available. |
To avoid having claims rejected, HCS and TxHmL providers should do the following before submitting claims to TMHP:
1. Check the TexMedConnect Medicaid Eligibility Service Authorization Verification (MESAV) for client service authorization, level, client hold, and eligibility information. The following client information should be verified:
- Services authorized for the client
- Service dates authorized for the client
- Levels authorized for the client
2. Use the HCS and TxHmL Bill Code Crosswalks to check for important claims information, such as the Line Item Control Number (LICN).
Chapters Added to YouTube Videos
Chapter links have been added to the videos in the HCS and TxHmL YouTube playlist. This allows viewers to jump directly to specific sections of each video to find the information they need.
To access the chapter links, follow these steps:
- Open the video from the playlist.
- Under the video title is a collapsed section that contains a description of the video. You can expand the description section by selecting Show more if you are using a web browser, or select more if you are using a mobile YouTube app.
- At the bottom of the expanded description section, the list of chapters will be shown as thumbnails with timestamps and titles. Select a chapter, and the video will start playing from that point.
View previous postings below:
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 17
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 16
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 15
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 14
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 13
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 12
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 11
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 10
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 9
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 8
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 7
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 6
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 5
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 4
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 3
HCS and TxHmL Waiver Programs: Trending Issue Support, Volume 2
HCS and TxHmL Waiver Programs: Trending Issue Support
Important Claims Submission Information for HCS and TxHmL Programs
LTC Online Portal Dashboard Accessibility Issue Resolved
IPC Forms 3608 and 8582 Issue Resolved
HCS and TxHmL FAQ Updates Available May 9, 2022, and May 23, 2022
Individual Plan of Care (IPC) Training Materials for HCS and TxHmL Waiver Programs
Now Available: HCS and TxHmL Programs Forms and Claims Submissions to TMHP
EVV Updates for the HCS and TxHmL Transition to TMHP for Claims Submission
For assistance with any further questions, contact the TMHP LTC Help Desk at 800-626-4117 (select option 1 and then option 7).